COVID-19 Vaccine Distribution


Steps in Vaccine Development and Distribution

The development of vaccines occurs in three main phases: research and development, manufacturing, and distribution. The research and development phase involves the bench-side research and in vitro studies to determine the composition of the vaccine. These studies evolve into in vivo clinical studies to ensure there are no harmful effects on humans, after which they are then authorized and approved by federal agencies. Once authorized, these vaccines can begin the manufacturing phase, which involves the mass production and shipment of the vaccine. These vaccines are then distributed to agencies which determine who gets the vaccine and when they get the vaccine.

Distribution within the United StatesEdit

Determining Vaccine Distribution in the United StatesEdit

Within the United States, vaccines are bought by the government and given to the Centers for Disease Control and Prevention (CDC) for allocation. The CDC determines vaccine distribution by requesting allocation plans from each US jurisdiction (this includes 50 states, seven large cities, and eight territories). To aid these jurisdictions in their plans, frameworks have been designed by the CDC’s Advisory Committee on Immunization Practice (ACIP) and the National Academies of Science, Engineering and Medicine (NASEM). Both frameworks aim to decrease the disparities in vaccine distribution and access, but do so in different ways[1]. This suggests that differences in plans from different jurisdictions could lead to differences in vaccine allocation based on jurisdiction, which could potentially lead to disparities forming across different jurisdictions.

Methods to Determining State/Local Vaccine DistributionEdit

COVID Vaccination Rates in the United States

Social Invulnerability Index (SVI)Edit

The SVI is a statistical measure which accounts for a geographical location's ability to respond to external negative stresses that impact a communities public health. This is accounted for from 15 different social factors that are grouped into four overarching groups: socioeconomic status, household composition and disability, minority status and language, and housing type and transportation[2]. An example of utilizing SVI was in Connecticut, where the SVI was used to determine the top 25% of counties that were most impacted by COVID-19[1].

Disadvantage IndicesEdit

A disadvantage index is the generalized term for any metric which takes into account social and public health disparities, of which the SVI is a particular metric. Other metrics exist as well, such as the Area Deprivation Index (ADI) and the Healthy Places Index (HPI). The ADI is similar to SVI, except that it does not take into account race as a social factor in order to eliminate potential legal implications[3]. This particular method was utilized in Alaska in order to identify specific geographic locations that were more at risk for COVID-19[1]. The HPI was employed by California in their vaccine allocation plan, which is based on eight “action areas” that are weighted based on importance[4]. Unique to the HPI are including environmental and climate change factors.


Due to the variety in allocation plans determined by states, the overall vaccine rollout across the United States varies greatly. Some states, such as Vermont and Maine, have had great success with over 150,000 doses administered per 100,000 people. However, other states (particularly in the south east) are lagging behind with less than 120,000 doses administered per 100,000 people[5]. This is partially due to the freedom given to states in terms of their allocation plans, and this difference in vaccine allocation has led to significant disparities in who gets vaccines. Studies have shown that the least vulnerable counties in the United States tend to have a higher average vaccination rate compared to counties that are the most vulnerable[6]. Specifically in New York City, it was shown that the zip codes impacted the most by the COVID-19 pandemic were the same zip codes that were primarily inhabited by minority populations. However, the highest vaccination rates were in zip codes that were significantly wealthier and were less impacted by COVID-19[7].

The disparity in vaccine distribution can not be isolated to a single factor, but there are two that are important to note. One factor is the lack of understanding and trust for the vaccine's effectiveness between different populations - which has prevented those communities from having a higher vaccination rate. This has given rise to the saying  “Vaccines don’t save lives, but vaccinations do”, which emphasizes the importance of public knowledge and trust for the vaccine in order for the vaccine to truly be effective on a larger scale. The other factor being that the CDC will not distribute new vaccines to a jurisdiction until they completely finish their previous shipment[1]. Therefore, it is in the jurisdictions best interest to deliver vaccines to communities where they know they will have a high vaccination rate.

Global DistributionEdit

COVID-19 vaccines were developed in record time. However, the equitable distribution of safe and effective vaccines across the globe has become a difficult task [8]. Despite representing less than half of the world population, 92% of COVID-19 vaccines were developed by China, the United States, the European Union, and India by March of 2021[9][10][11]. This leaves a majority of nations with poor economies or pharmaceutical infrastructure unable to provide vaccinations to the entirety of their populations. Worldwide COVID-19 vaccination distribution is therefore necessary to save lives and encourage global economic recovery.


Started in April of 2020, COVID-19 Vaccines Global Access, COVAX, is a worldwide effort working to deliver COVID-19 vaccinations to low-to-middle-income countries. The initiative is formally directed by the GAVI vaccine alliance, the Coalition for Epidemic Preparedness Innovations (CEPI), and the World Health Organization (WHO) as one of the three pillars of the Access to COVID-19 Tools Accelerator. COVAX coordinates the distribution of a wide portfolio of vaccines by acquiring doses from affluent countries and delivering these doses to countries in need[12]. The group works under the mission as set forth by Dr. Seth Berkley, CEO of Gavi: “nobody is safe until everybody is safe”[13][14]. As of November 2021, COVAX-approved candidates included Oxford–AstraZeneca, Pfizer–BioNTech, Moderna, Sinopharm BIBP, CoronaVac, Janssen and Covaxin vaccines for emergency use[15]. These vaccines are manufactured and distributed between a network of 180 total countries[16].

The COVAX framework includes recipient and donor nations. Receiving countries are further stratified into those which are able to self-finance and 92 nations covered by a fund called the Advance Market Commitment (AMC). AMC donations are provided by donors which include thirty countries and several independent philanthropies[16]. As of November 2021, more than ten billion dollars has been guaranteed to the COVAX AMC fund.


The first COVAX vaccines were delivered to Ghana in February of 2021[17]. COVAX directors worked directly with representatives from Ghana and other countries to overcome the lack of infrastructures in third world countries by delivering vaccines via drones[18]. As of December 6th, 2021, COVAX has shipped over 610 million vaccines to 144 participating countries[19]. These inoculations are targeted toward healthcare workers, elderly populations, and young people with underlying conditions.

Upon initiation of the program, COVAX aimed to deliver 2 billion doses by the end of 2021. This amount was projected to end the acute phase of the pandemic by vaccinating 20% of each country’s populations[12]. The disparities between predicted and achieved vaccine rollout may mostly be attributed to the idea of vaccine nationalism.

Vaccine NationalismEdit

Vaccine Nationalism is an attribute of several affluent nations who produce COVID-19 vaccinations but retain these medicines for the benefit of their own national populations[20]. Vaccine nationalism is further propagated by capitalistic and political gain. Many vaccine manufacturers are reluctant to share intellectual properties regarding vaccine contents or manufacturing methods for fear of profit loss[21]. Politicians have utilized nationally created vaccines as proponents for their election and symbols of their countries power[20]. These actions directly oppose the mission of COVAX seeking equitable distribution to all countries regardless of economic status.

Vaccine Access and SocietyEdit

Vaccination TrendsEdit

Global vaccine trends have seen wealthier countries gain access to vaccines far before less wealthy nations. Although at the time of writing (Dec. 9, 2021) the vaccination rate is starting to steady out over the globe, parts of the Middle East and Eastern Europe as well as much of Africa are still lagging behind [22]. This trend continues to the individual level, where wealthier parts of the population were much more likely to have had at least one dose of the vaccine compared to those in lower income brackets[23].

Another trend that was seen globally is priority vaccinations for the elderly, immunocompromised, and frontline healthcare workers. Although the CDC is not a global entity, its recommendations based on the goals to ”decrease death and serious disease as much as possible, preserve functioning of society, [and] reduce the extra burden COVID-19 had on people already facing disparities” were followed through most parts of the world[24]. With these goals in mind, the first groups to get priority access for vaccinations included the elderly and immunocompromised, who were more at risk of severe illness or death due to COVID-19. Healthcare workers were also highly prioritized, as they  had a much higher chance of coming into contact with the virus.

Vaccine IncentivesEdit

Throughout the pandemic, many incentives have risen for reasons to both get and not get the vaccine. A few will be discussed below.

Monetary incentivesEdit

Monetary incentives are always a strong driver for any goal, but especially for the creation, distribution and administration of vaccines. Countries have a strong incentive to create and promote their vaccine technology to promote their economy and pharmaceutical businesses. This can also be problematic for countries who do not have the means to create their own vaccine, as they must wait for doses from wealthier countries. For the individual, governments have offered incentives for people to get the vaccine, such as lotteries and handouts for those who get them[25].

Power incentivesEdit

Developing a vaccine proves a country is a global leader in science and pharmaceuticals, which is a strong display of the country’s wealth, intelligence and power. A country may then want to distribute their vaccine to their allied countries, or reject a vaccine made by their opponents. Getting a vaccine (or not) can also limit personal power as well. Many places have rules regarding those who are vaccinated or unvaccinated, and some countries such as Austria are going so far as to lift their lockdown for the vaccinated but not for the unvaccinated[26].

Vaccine HesitancyEdit

Unfortunately, the rise in vaccine hesitancy and misinformation has taken a toll on the vaccine rollout both in the US and around the world. Distrust in the speed of development of the COVID-19 vaccine, distrust of governments, distrust of the medical and scientific communities, and trust of certain political leaders and organizations have all lead to an increase in the anti-vaccination movement, with misinformation being a major driver behind this[27][28][29]. This has left countries with incredibly high access to vaccines with lower-than-expected vaccination rates. An example is the United States, where only 60% of the population is fully vaccinated even with widespread vaccine access[30].


In response to the COVID-19 pandemic, governments around the world have been forced to take action on federal and global stages. This has been seen in the United States through institutions of programs which determine the prioritized distribution of vaccines. COVAX, which is an international movement, continues to oversee the direction of vaccine supplies to all countries regardless of their economic status. In spite of these initiatives, vaccine nationalism and societal beliefs continue to resist efficient distribution at all levels, since they are reluctant to share intellectual properties. Through all distribution related challenges including the amount of doses administered, the truth of the pandemic stays the same: vaccines don't save lives, vaccinations do.


  1. a b c d Schmidt, H., Weintraub, R., Williams, M. A., Miller, K., Buttenheim, A., Sadecki, E., Wu, H., Doiphode, A., Nagpal, N., Gostin, L. O., & Shen, A. A. (2021). Equitable allocation of COVID-19 vaccines in the United States. Nature Medicine, 27(7), 1298–1307.
  2. Centers for Disease Control and Prevention. (2021, September 20). CDC SVI documentation 2018. Centers for Disease Control and Prevention. Retrieved December 9, 2021, from
  3. Tipirneni, R., Lantz, P. M., & Karmakar, M. (2021, June 11). Comparison of Social Vulnerability index and area deprivation index assessing COVID-19 outcomes. Institute for Healthcare Policy & Innovation. Retrieved December 9, 2021, from
  4. Public Health Alliance of Southern California. (n.d.). About. California Healthy Places Index. Retrieved December 9, 2021, from
  5. Centers for Disease Control and Prevention. (n.d.). CDC Covid Data tracker. Centers for Disease Control and Prevention. Retrieved December 9, 2021, from
  6. The New York Times. (2020, December 17). See how vaccinations are going in your county and State. The New York Times. Retrieved December 9, 2021, from
  7. Zhang, C., & Bushey, C. (2021, February 20). Racial Inequality Plagues US Vaccine Rollout. Financial Times. Retrieved December 9, 2021, from
  8. World Health Organization. Vaccine equity. World Health Organization. Retrieved December 9, 2021, from
  9. Lawler, D. (2021, March 19). The countries producing the most covid-19 vaccines. Axios. Retrieved December 9, 2021, from
  10. Covid-19. Airfinity. Retrieved December 9, 2021, from
  11. Total population by country 2021. Retrieved December 9, 2021, from
  12. a b COVAX explained. Gavi, the Vaccine Alliance. Retrieved December 9, 2021, from
  13. 92 low- and middle-income economies eligible to get access to COVID-19 vaccines through Gavi COVAX AMC. Gavi, the Vaccine Alliance. Retrieved December 9, 2021, from
  14. Gavi and global health actors collaborate to accelerate COVID-19 technologies for all. Gavi, the Vaccine Alliance. Retrieved December 9, 2021, from
  15. Status of covid-19 vaccines... Retrieved December 9, 2021, from
  16. a b The Gavi COVAX AMC explained. Gavi, the Vaccine Alliance. Retrieved December 9, 2021, from
  17. Steinhauser, G. (2021, February 24). Ghana is First Nation to get free covid-19 vaccines under covax plan. The Wall Street Journal. Retrieved December 9, 2021, from
  18. Drone delivered covid-19 vaccines take to the air. Gavi, the Vaccine Alliance. Retrieved December 9, 2021, from
  19. COVAX vaccine roll-out. Gavi, the Vaccine Alliance. Retrieved December 9, 2021, from
  20. a b Vanderslott, S., Emary, K., Naude, R. te W., English, M., Thomas, T., Patrick-Smith, M., Henry, J., Douglas, N., Moore, M., Stuart, A., Hodgson, S. H., & Pollard, A. J. (2021, October 1). Vaccine nationalism and internationalism: Perspectives of COVID-19 vaccine trial participants in the United Kingdom. BMJ Global Health. Retrieved December 9, 2021, from
  21. Wouters, O. J. (2021, February 12). Challenges in ensuring global access to COVID-19 vaccines: production, affordability, allocation, and deployment. Health Policy. Retrieved December 9, 2021, from
  22. World Health Organization. (2021, Dec. 9). Who coronavirus (COVID-19) dashboard. World Health Organization. Retrieved December 9, 2021, from
  23. Rouw, A., Wexler, A., Kates, J., & Michaud, J. (2021, July 21). Tracking Global Covid-19 Vaccine Equity. KFF. Retrieved December 9, 2021, from
  24. Centers for Disease Control and Prevention. (2021, November 15). How CDC is making COVID-19 vaccine recommendations. Centers for Disease Control and Prevention. Retrieved December 9, 2021, from
  25. Walkey, A. J., Law, A., & Bosch, N. A. (2021, August 24). Lottery-based incentive in Ohio and covid-19 vaccination rates. JAMA. Retrieved December 9, 2021, from
  26. Eder, M. (2021, December 7). Austria Will End Lockdown for Vaccinated People. Retrieved December 9, 2021, from
  27. Crist, C. (2021, March 25). 'Disinformation Dozen' Driving Anti-Vaccine Content. WebMD. Retrieved December 9, 2021, from
  28. Hornsey, M. (2021, August 10). The Psychology of the Anti-Vaccine Movement. Portland Press. Retrieved December 9, 2021, from
  29. Chen, S. (2021, September 19). The Anti-Vax Movement is Being Radicalized by Far-Right Political Extremism. The Conversation. Retrieved December 9, 2021, from
  30. Mayo Foundation for Medical Education and Research. (2021, December 9). U.S. COVID-19 Vaccine Tracker. Mayo Clinic. Retrieved December 9, 2021, from